长期卧床脑卒中患者并发坠积性肺炎的影响因素

Risk factor analysis for hypostatic pneumonia in bedridden stroke patients

目的探讨长期卧床脑卒中患者并发坠积性肺炎的因素。方法回顾性研究2011年1月至2015年8月在北京市监狱管理局中心医院诊治的长期卧床脑卒中患者220例,对患者的临床资料与预后情况进行调查,记录坠积性肺炎的发生情况,单因素与logistic回归分析坠积性肺炎发生的危险因素。结果 220例患者中发生坠积性肺炎40例,发生率为18.2%。单因素分析显示年龄、卒中类型、糖尿病、吸烟、吞咽障碍、预防性使用抗菌药物、卧床时间与坠积性肺炎相关,进一步logistic回归分析显示年龄、糖尿病、吞咽障碍、预防性使用抗菌药物、卧床时间是坠积性肺炎的危险因素(P<0.05)。坠积性肺炎患者入院21天的NIHSS评分为(11.23±3.45)分,而非坠积性肺炎患者为(4.19±3.10)分,对比差异有统计学意义(P<0.05);同时坠积性肺炎患者入院21天的其他并发症发生率与病死率也都高于对照组,差异有统计学意义(P<0.05)。结论长期卧床脑卒中患者并发坠积性肺炎比较常见,主要危险因素包括年龄、糖尿病、吞咽障碍、预防性使用抗菌药物、卧床时间等因素。

Objective To investigate the risk factors of hypostatic pneumonia in the bedridden stroke patients. Methods The clini-cal data and prognosis of 220 cases of bedridden stroke patients, hospitalized in our hospital from Jan 2011 to Aug 2015, were retrospectively studied, and the occurrence of hypostatic pneumonia was recorded. The univariate and logistic regression analysis for the risk factors of hypo-static pneumonia were performed. Results There were 40 patients with hypostatic pneumonia in the 220 bedridden stroke patients, with in-cidence rate of 18. 2%. The univariate analysis showed that age, stroke classification, diabetes, smoking, dysphagia, prophylactic use of an-tibiotics and bedridden time were related to hypostatic pneumonia in those patients. The logistic regression analysis further showed that age, diabetes, dysphagia, prophylactic use of antibiotics and bedridden time were the risk factors of hypostatic pneumonia （P〈0. 05）. The NIH-SS score of the patients with hypostatic pneumonia at 21 days after admission was 11. 23 ± 3. 45, whereas the NIHSS score of other patients was 4. 19 ± 3. 10, and the difference between them was statistically significant （P〈0. 05）. Meanwhile, the incidence of other complications and the mortality in these patients with hypostatic pneumonia at 21 days after admission were also significantly higher than those in the pa-tients without hypostatic pneumonia （ P〈0. 05 ） . Conclusion In those bedridden stroke patients, occurrence of hypostatic pneumonia is common, and its primary risk factors include age, diabetes, dysphagia, prophylactic use of antibiotics and bedridden time, which would worsen their prognosis and call for great concern and active prevention of the clinicians.